Skip to main content

Advertisement

SpringerLink
Log in

The QuantiFERON®-TB-GOLD Assay for Tuberculosis Screening in Healthcare Workers: A Cost-Comparison Analysis

  • Published:
Lung Aims and scope Submit manuscript

Abstract

The aim of this study was to assess the costs of screening healthcare workers (HCWs) for tuberculosis (TB) using the novel interferon-γ release assay QuantiFERON®-TB Gold In-tube (QFT) versus the tuberculin skin test (TST). We used a prospective observational study with a cost-comparison analysis. The study was conducted at a regional center for ambulatory TB treatment. The study included 100 Israeli HCWs who were referred for routine TB screening. The participants were tested with both TST and QFT. For the TST, induration of 10 mm or more was considered a positive test. For the QFT, a threshold of 0.35 IU/ml interferon-γ above background levels was a positive test. We developed a computerized model of the present TST-only screening method versus the QFT either alone (instead of the TST) or as a confirmatory test for a positive TST. Of the 100 subjects, 34 had a positive TST result and 17 had a positive QFT result. There was poor agreement between the TST and the QFT (κ = 0.19). Assuming adherence to treatment of 50%, costs were minimized by using the QFT to confirm a positive TST (€4155). The QFT-only model was cheaper than the TST-only model (€7280 vs. €8217, respectively). The QFT-only method required the fewest clinic visits (121) compared to the TST (344). Adherence to treatment in the QFT-positive group was 47% compared with 12% for the TST-positive group. Screening HCWs with the QFT test compared to the TST resulted in fewer possible cases being identified, lower costs, and increased adherence to treatment. Costs were minimized by using the QFT to confirm a positive TST. A QFT-based screening program for HCWs is feasible and should be evaluated systematically.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Cohn D, O’Brien R (2000) Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society. MMWR Recomm Rep 49:1–51

    Google Scholar 

  2. Menzies D, Joshi R, Pai M (2007) Risk of tuberculosis infection and disease associated with work in health care settings. Int J Tuberc Lung Dis 11:593–605

    CAS  PubMed  Google Scholar 

  3. Pouchot J, Grasland A, Collet C, Coste J, Esdaile JM, Vinceneux P (1997) Reliability of tuberculin skin test measurement. Ann Intern Med 126:210–214

    CAS  PubMed  Google Scholar 

  4. Wang L, Turner MO, Elwood RK, Schulzer M, FitzGerald JM (2002) A meta-analysis of the effect of Bacille Calmette Guérin vaccination on tuberculin skin test measurements. Thorax 57:804–809

    Article  CAS  PubMed  Google Scholar 

  5. QuantiFERON®-TB Gold In-tube assay, package insert, Cellestis, 2007. Available at www.cellestis.com [accessed 12 December 2007]

  6. Pai M, Zwerling A, Menzies D (2008) Systematic review: T-cell-based assays for the diagnosis of latent tuberculosis infection: an update. Ann Intern Med 149:177–184

    PubMed  Google Scholar 

  7. Diel R, Loddenkemper R, Meywald-Walter K, Niemann S, Nienhaus A (2008) Predictive value of a whole blood IFN-gamma assay for the development of active tuberculosis disease after recent infection with Mycobacterium tuberculosis. Am J Respir Crit Care Med 177:1164–1170

    Article  PubMed  Google Scholar 

  8. Aichelburg MC, Rieger A, Breitenecker F, Pfistershammer K, Tittes J, Eltz S, Aichelburg AC, Stingl G, Makristathis A, Kohrgruber N (2009) Detection and prediction of active tuberculosis disease by a whole-blood interferon-gamma release assay in HIV-1-infected individuals. Clin Infect Dis 48:954–962

    Article  CAS  PubMed  Google Scholar 

  9. Diel R, Nienhaus A, Loddenkemper R (2007) Cost-effectiveness of interferon-gamma release assay screening for latent tuberculosis infection treatment in Germany. Chest 131:1424–1434

    Article  PubMed  Google Scholar 

  10. Wrighton-Smith P, Zellweger J (2006) Direct costs of three models for the screening of latent tuberculosis infection. Eur Respir J 28:45–50

    Article  CAS  PubMed  Google Scholar 

  11. Diel R, Nienhaus A, Lange C, Schaberg T (2006) Cost-optimisation of screening for latent tuberculosis in close contacts. Eur Respir J 28:35–44

    Article  CAS  PubMed  Google Scholar 

  12. Oxlade O, Schwartzman K, Menzies D (2007) Interferon-gamma release assays and TB screening in high-income countries: a cost-effectiveness analysis. Int J Tuberc Lung Dis 11:16–26

    CAS  PubMed  Google Scholar 

  13. Seidler A, Nienhaus A, Diel R (2005) Review of epidemiological studies on the occupational risk of tuberculosis in low-incidence areas. Respiration 72:431–446

    Article  PubMed  Google Scholar 

  14. Tam CM, Leung CC (2006) Occupational tuberculosis: a review of the literature and the local situation. Hong Kong Med J 12:448–455

    CAS  PubMed  Google Scholar 

  15. Pollock N, Campos-Neto A, Kashino S, Napolitano D, Behar S, Shin D, Sloutsky A, Joshi S, Guillet J, Wong M, Nardell E (2008) Discordant QuantiFERON-TB Gold test results amongst US healthcare workers with increased risk of latent tuberculosis infection: a problem or solution? Infect Control Hosp Epidemiol 9:878–886

    Article  Google Scholar 

  16. Pai M, Joshi R, Dogra S, Mendiratta DK, Narang P, Kalantri S, Reingold AL, Colford JM, Riley LW, Menzies D (2006) Serial testing of health care workers for tuberculosis using interferon-gamma assay. Am J Respir Crit Care Med 174:349–355

    Article  CAS  PubMed  Google Scholar 

  17. Pai M, Gokhale K, Joshi R, Dogra S, Kalantri S, Mendiratta DK, Narang P, Daley CL, Granich RM, Mazurek GH, Reingold AL, Riley LW, Colford JM (2005) Mycobacterium tuberculosis infection in health care workers in rural India: comparison of a whole-blood interferon gamma assay with tuberculin skin testing. JAMA 293:2746–2755

    Article  CAS  PubMed  Google Scholar 

  18. Harada N, Nakajima Y, Higuchi K, Sekiya Y, Rothel J, Mori T (2006) Screening for tuberculosis infection using whole-blood interferon-gamma and Mantoux testing among Japanese healthcare workers. Infect Control Hosp Epidemiol 27:442–448

    Article  PubMed  Google Scholar 

  19. Soborg B, Andersen AB, Larsen HK, Weldingh K, Andersen P, Kofoed K, Ravn P (2007) Detecting a low prevalence of latent tuberculosis among health care workers in Denmark detected by M. tuberculosis-specific IFN-gamma whole-blood test. Scand J Infect Dis 39:554–559

    Article  PubMed  Google Scholar 

  20. Ozdemir D, Annakkaya AN, Tarhan G, Sencan I, Cesur S, Balbay O, Guclu E (2007) Comparison of the tuberculin skin test and the quantiferon test for latent mycobacterium tuberculosis infections in health care workers in Turkey. Jpn J Infect Dis 60:102–105

    CAS  PubMed  Google Scholar 

  21. Nienhaus A, Schablon A, Bâcle C, Siano B, Diel R (2008) Evaluation of the interferon-gamma release assay in healthcare workers. Int Arch Occup Environ Health 81:295–300

    Article  CAS  PubMed  Google Scholar 

  22. de Perio MA, Tsevat J, Roselle GA, Kralovic SM, Eckman MH (2009) Cost-effectiveness of interferon gamma release assays vs tuberculin skin tests in health care workers. Arch Intern Med 169:179–187

    Article  PubMed  Google Scholar 

  23. Miranda C, Yen-Lieberman B, Terpeluk P, Tomford JW, Gordon S (2009) Reducing the rates of indeterminate results of the QuantiFERON-TB Gold in-tube test during routine preemployment screening for latent tuberculosis infection among healthcare personnel. Infect Control Hosp Epidemiol 30:296–298

    Article  PubMed  Google Scholar 

  24. Israel Ministry of Health, medical services price list. Available at www.health.gov.il/pages/default.asp?PageId=827&catId=111&maincat=1 [accessed 29 July 2008]

  25. Royal College of Physicians (2006) Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control. Royal College of Physicians, London. Available at www.nice.org.uk

  26. Diel R, Wrighton-Smith P, Zellweger JP (2007) Cost-effectiveness of interferon-gamma release assay testing for the treatment of latent tuberculosis. Eur Respir J 30:321–332

    Article  CAS  PubMed  Google Scholar 

  27. Gershon AS, McGeer A, Bayoumi A, Raboud J, Yang J (2004) Health care workers and the initiation of treatment for latent tuberculosis infection. Clin Infect Dis 39:667–672

    Article  PubMed  Google Scholar 

  28. Shukla SJ, Warren DK, Woeltje KF, Gruber CA, Fraser VJ (2002) Factors associated with the treatment of latent tuberculosis infection among health-care workers at a midwestern teaching hospital. Chest 122:1609–1614

    Article  PubMed  Google Scholar 

  29. Friedman LN, Nash ER, Bryant J, Henry S, Shi J, D’Amato J, Khaled G, Russi MB, O’Connor PG, Edberg SC, Pisani MA, Cain HC, Tanoue L, Weissman DN (2006) High rate of negative results of tuberculin and quantiferon tests among individuals with a history of positive skin test results. Infect Control Hosp Epidemiol 27:436–441

    Article  PubMed  Google Scholar 

  30. de Vries G, Sebek MMGG, van Weezenbeek CSBL (2006) Healthcare workers with tuberculosis infected during work. Eur Respir J 28:1216–1221

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful to Michal Sabo, Orna David, and Ruth Sela for their enthusiastic administrative support throughout this study. The research was funded internally by both the Pulmonary Institute of Rabin Medical Center and Maccabi Health Services.

Author information

Authors and Affiliations

  1. Tuberculosis Center, Maccabi Health Services, 32 Aharoni Street, Rehovot, 76282, Israel

    Benjamin D. Fox, Rachel Preiss, Victoria Rusanov, Leonardo Fuks, Nir Peled, Ilanit Haim, Meir Raz & David Shitrit

  2. Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petach Tiqwa, Israel

    Benjamin D. Fox, Mordechai R. Kramer, Victoria Rusanov, Leonardo Fuks, Nir Peled & David Shitrit

  3. Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Benjamin D. Fox, Mordechai R. Kramer & David Shitrit

  4. Ministry of Health, Ramle District, Israel

    Zohar Mor

Authors
  1. Benjamin D. Fox
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mordechai R. Kramer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zohar Mor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rachel Preiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Victoria Rusanov
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Leonardo Fuks
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nir Peled
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ilanit Haim
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Meir Raz
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. David Shitrit
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benjamin D. Fox.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fox, B.D., Kramer, M.R., Mor, Z. et al. The QuantiFERON®-TB-GOLD Assay for Tuberculosis Screening in Healthcare Workers: A Cost-Comparison Analysis. Lung 187, 413–419 (2009). https://doi.org/10.1007/s00408-009-9182-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-009-9182-2

Keywords

Search

Navigation